Stroke Presentation and Outcome in Developing Countries
- 1 July 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 36 (7), 1388-1393
- https://doi.org/10.1161/01.str.0000170717.91591.7d
Abstract
Background and Purpose— Despite increasing burden of stroke in Africa, prospective descriptive data are rare. Our objective was to describe, in The Gambia, the clinical outcome of stroke patients admitted to the Royal Victoria Teaching Hospital in the capital Banjul, to assess mortality and morbidity, and propose preventive and therapeutic measures. Methods— Prospective data were collected on consecutive patients older than 15 years old admitted between February 2000 and February 2001 with the diagnosis of nonsubarachnoid stroke. Risk factors, clinical characteristics, and social consequences were assessed using a modified National Institutes of Health Stroke Scale (mNIHSS), the Barthel Activity in Daily Living scale, the Siriraj score for subtypes, and the Bamford criteria for location/extension. Patients were followed-up at home up to 1 year after discharge. Results— Ninety-one percent (148/162) of eligible patients were enrolled and followed-up. Hypertension and smoking were the most prevalent risk factors. Severity was high at admission, especially in women, and was strongly correlated to the outcome. mNIHSS and consciousness level on admission were strong predictors of the mortality risk. Swallowing difficulties at admission, fever, lung infection, and no aspirin treatment were, independently, risk factors for a lethal outcome susceptible to being addressed by treatment. Mortality was 41% in-hospital and 62% after 1 year. In survivors, autonomy levels improved over time. Drug compliance was poor. At home, family members provided care. Long-term socioeconomic and cultural activities were affected in most patients. Conclusions— Case-fatality was high compared with Western cohorts. Preventive measures can be developed. Rational treatment, in the absence of head imaging for initial assessment, requires adapted protocols. Providers should be trained, both at hospital and community levels.This publication has 9 references indexed in Scilit:
- Stroke in a Biracial PopulationStroke, 2004
- Use of the Original, Modified, or New Intracerebral Hemorrhage Score to Predict Mortality and Morbidity After Intracerebral HemorrhageStroke, 2003
- Mortality and Recovery After Stroke in The GambiaStroke, 2003
- Alternative strategies for stroke care: a prospective randomised controlled trialThe Lancet, 2000
- Stroke mortality in urban and rural TanzaniaThe Lancet, 2000
- Nationwide prevalence study of hypertension and related non‐communicable diseases in The GambiaTropical Medicine & International Health, 1997
- CAST: randomised placebo-controlled trial of early aspirin use in 20 000 patients with acute ischaemic strokeThe Lancet, 1997
- Siriraj stroke score and validation study to distinguish supratentorial intracerebral haemorrhage from infarction.BMJ, 1991
- A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981-86. 1. Methodology, demography and incident cases of first-ever stroke.Journal of Neurology, Neurosurgery & Psychiatry, 1988